The Nasal Tip

Part of what makes rhinoplasty such a tremendously interesting surgical procedure, is that there exists an interrelated geometry and physics among the various structures of the nose. That is, no isolated anatomic structure can be assessed, or certainly manipulated, without consideration of other anatomic structures. Each anatomic element of the nose exists in relation to the others, and maintaining a balance among the elements is the beautiful symphony that is rhinoplasty.

This thoughtfulness needs to be observed with regard to both considerations of form, as well as function. An overly narrowed middle vault of the nose may afford a small relative aesthetic gain for a certain nose, but the associated compromise in breathing may render the small aesthetic improvement unworthy. Decisions like these are made all of the time before and during the rhinoplasty procedure.

Regarding modifications of the nasal tip, true success comes in balance of appropriate aesthetic refinement with integrity of structure. That is, the tip should appear defined and well-shaped, but should be strong and afford adequate intranasal patency.

Nasal tip refinement is perhaps of the most engaging endeavors for the facial plastic surgeon. A focused preoperative assessment with subsequent preoperative planning, bring to fruition the execution of the surgical plan which factors in fractions of millimeters. The level of attention to detail is at its highest among facial surgical procedures. Intricate, delicate, exact maneuvers are made to implement a plan designed to balance the rotation, projection, refinement, and general shape of the nasal tip. The vision of the surgeon combines scientific anatomic understanding, with artistic sensibility.

Interestingly, at the end and after healing, as I tell many of my patients, the nasal tip most perfectly addressed, is one which is never noticed. The beautiful nose shrugs the viewer past it, to instead focus upon the eyes.